Neovascular glaucoma is a severe form of secondary glaucoma in which abnormal new blood vessels grow over the iris and drainage angle, blocking fluid outflow and causing very high eye pressure.
Underlying Conditions
It usually develops in eyes with extensive retinal ischaemia, such as proliferative diabetic retinopathy or central retinal vein occlusion, where the eye releases vascular endothelial growth factor (VEGF).
- New vessels can initially present as rubeosis iridis (fine vessels on the iris surface).
- As membranes contract, the angle closes and pressure can rise rapidly.
- Symptoms include pain, redness, blurred vision, and headache in advanced stages.
- Left untreated, it often leads to profound sight loss and a painful eye.
Treatment
Management focuses on regressing neovascularisation and controlling pressure using anti‑VEGF injections, panretinal photocoagulation, and pressure‑lowering medications or surgery.
- Early anti‑VEGF can quickly reduce iris and angle vessels, facilitating further treatment.
- Glaucoma surgery (tubes, trabeculectomy, or cyclodiode) is often required for pressure control.
- Systemic risk factors such as diabetes and hypertension must be optimised.
- Prognosis depends on how early the condition is detected and treated.
